Current initial therapy of stage III and IV ovarian cancer: challenges for managed care

Patients with advanced ovarian cancer (International Federation of Gynecology and Obstetrics stage III or stage IV) have improved their long-term prognosis, but the majority will still die of their disease. The current standard therapy, which involves aggressive cytoreductive surgery (removal of all visible tumor) followed by platinum/paclitaxel chemotherapy, has increased 5-year survival rates considerably over the last three decades. The choice of treatment for patients with stage III or IV disease in the managed care setting must consider survival rates, patient quality of life, and cost-effectiveness. Two chemotherapy combinations, cisplatin/paclitaxel and carboplatin/paclitaxel, appear comparable in efficacy in advanced disease, but are currently being investigated in clinical trials to compare side effects, quality-of-life parameters, and cost-effectiveness. The results of these trials may determine which chemotherapy combination becomes the standard of care for first-line treatment. Managed care organizations and patients can also benefit from a multidisciplinary approach to cancer care that includes additional support, such as risk assessment programs, the use of specialists (gynecologic oncologists), and psychosocial counseling. As the search for more effective agents and other therapeutic modalities continues, the focus of future research may be to find specific biomarkers of ovarian cancer, which will help detect disease at its earliest stages.